描述在拒绝治疗、不依从治疗和放弃治疗（TRNA）的情况下考虑的法律选择的范围；临床医生关于法律干预的思维过程；以及法律介入的后果。我们在 2019 年 5 月至 9 月期间对 30 名儿科肿瘤学家进行了深入的半结构化访谈，了解 TRNA 的经验。访谈指南涵盖了遇到的冲突类型；应对措施中考虑的因素和策略； TRNA 病例对个人和职业的影响；道德框架和法律要求的作用；以及管理 TRNA 病例所需的资源。使用主题分析对访谈进行反复转录和编码。参与者代表了各种机构规模、地理位置和实践年限。 30 名受访者中有 25 名讨论了有关 TRNA 的法律考虑。大多数参与者首先通过儿童保护服务机构接触法律系统。他们考虑了患者年龄、治疗效果、生活质量（治疗负担）和预后；家庭资源和社会背景；治疗关系的保存以及报告可能产生的后果。法律介入的经验和结果各不相同。临床医生在报告医疗疏忽的义务和担心报告可能对相关儿童造成弊大于利之间的紧张关系中挣扎。我们迫切需要医疗保健专业人员与儿童保护服务机构和法律专业人员之间进行更多对话。两个群体的利益相关者都将从对对方思维过程的深入了解中受益；相关事实的清晰度；并共同努力寻求创造性的、基于证据的解决方案来应对这些复杂的挑战。版权所有 © 2024 美国儿科学会。

To characterize the spectrum of legal options considered in cases of treatment refusal, nonadherence, and abandonment (TRNA); clinicians' thought processes regarding legal intervention; and perceived consequences of legal involvement.We conducted in-depth, semistructured interviews with 30 pediatric oncologists between May and September of 2019 regarding experiences with TRNA. The interview guide covered types of conflicts encountered; factors and strategies considered in response; effects of TRNA cases, personally and professionally; the role of ethical frameworks and legal requirements; and resources needed to manage TRNA cases. Interviews were transcribed and coded iteratively using thematic analysis.Participants represented a range of institutional sizes, geographic locations, and years in practice. Twenty-five of 30 interviewees discussed legal consideration with regard to TRNA. Most participants first engaged the legal system through child protective service agencies. They considered patient age, treatment efficacy, quality of life (burden of treatment), and prognosis; family resources and social context; and preservation of therapeutic relationships and possible consequences of reporting. Experiences and outcomes of legal involvement varied.Clinicians struggle with the tension between obligations to report medical neglect and fears that reporting may result in more harm than benefit to the child in question. We urgently need more dialog between health care professionals and child protective services and legal professionals. Stakeholders from both groups would benefit from a greater understanding of the other's thought processes; clarity regarding the relevant facts; and mutual progress toward creative, evidence-based solutions to working out these complex challenges.Copyright © 2024 by the American Academy of Pediatrics.